title: Intracytoplasmic morphologically selected sperm injection is beneficial in cases of advanced maternal age: a prospective randomized study.
abstract: OBJECTIVE
  To evaluate advanced maternal age as a rationale for performing intracytoplasmic morphologically selected sperm injection (IMSI).
  
  
  METHODS
  This study included couples undergoing intracytoplasmic sperm injection (ICSI) as a result of advanced maternal age (≥37 years old). Sample size calculations were based on the assumption that a 15% difference in implantation rate would mean a clinically significant difference. To achieve this difference, 33 cycles would be needed in each treatment arm (with a significance level of 5% and power of 85%). Couples were randomly allocated to one of two sperm selection procedures (ICSI, n=33; or IMSI, n=33). Sperm selection in the ICSI group was analyzed under a magnification of 400×. Sperm selection in the IMSI group was analyzed under high magnification of 6600×. The groups were compared with regard to the outcome of the cycles.
  
  
  RESULTS
  IMSI cycles showed significantly higher implantation (4/33, 12.1% vs. 18/47, 38.3%, p=0.026) and pregnancy (4/29, 13.8 vs. 18/30, 60.0%, p<0.001) rates. The IMSI procedure positively influenced the blastocyst formation rate (RC: 15.00, R2: 49.9%, p=0.001) and implantation rate (RC: 24.04, R2: 9.6, p=0.027), and was determinant to the increased odds of pregnancy (OR: 9.0, CI: 2.17-37.38, p=0.001).
  
  
  CONCLUSIONS
  It seems that the injection of a morphologically normal spermatozoon overcomes the low oocyte quality in older women, resulting in improved embryo quality and in a 9-fold increase in the clinical pregnancy rate in couples with advanced maternal age.
authors.affiliation: Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, 04503-040 São Paulo, SP, Brazil; Fertility - Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, 01401-002 São Paulo, SP, Brazil.
authors.forename: A S
authors.initials: AS
authors.lastname: Setti
authors.forename: R C S
authors.initials: RC
authors.lastname: Figueira
authors.forename: D P A F
authors.initials: DP
authors.lastname: Braga
authors.forename: T
authors.initials: T
authors.lastname: Aoki
authors.forename: A
authors.initials: A
authors.lastname: Iaconelli
authors.forename: E
authors.initials: E
authors.lastname: Borges
mesh_terms: D000328:Adult; D010064:Embryo Implantation; D005260:Female; D006801:Humans; D008297:Male; D008423:Maternal Age; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013094:Spermatozoa / Q000166:cytology*
keywords: ICSI; IMSI; Oocyte quality; Sperm morphology